Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction

TLDR

In hospitals with high patient-to-nurse ratios, surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses are more likely to experience burnout and job dissatisfaction.

 

The article investigates the relationship between nurse staffing levels and patient outcomes, specifically mortality and failure-to-rescue, in Pennsylvania hospitals. The researchers used a cross-sectional study design, analyzing linked data from nurse surveys, patient discharge abstracts, and hospital administrative databases to assess the impact of patient-to-nurse ratios on both patient mortality and nurse job satisfaction and burnout. They found that higher patient-to-nurse ratios were significantly associated with increased risk-adjusted patient mortality, failure-to-rescue rates, and higher levels of nurse burnout and job dissatisfaction. The study concludes that the California hospital nurse staffing legislation, which mandates minimum patient-to-nurse ratios, is a credible approach to reducing patient mortality and improving nurse retention in hospitals.

Briefing Document: Nurse Staffing and Hospital Outcomes

Source: Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J., & Silber, J.H. (2002). Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. JAMA, 288(16), 1987-1993.
Context: The study investigates the critical relationship between nurse staffing levels and patient outcomes, alongside the impact on nurse retention. It responds to the growing concern over a hospital nurse shortage and the implementation of minimum patient-to-nurse ratios in California.

Objective:

• Determine the association between patient-to-nurse ratios and patient mortality, including “failure-to-rescue” (deaths following complications) in surgical patients.
• Analyze the relationship between patient-to-nurse ratios and factors impacting nurse retention, such as burnout and job dissatisfaction.

Design: Cross-sectional analysis of linked data from:

• Surveys of 10,184 staff nurses
• Discharge data of 232,342 general, orthopedic, and vascular surgery patients
• Administrative data from 168 nonfederal adult general hospitals in Pennsylvania.

Key Findings:

• Increased Mortality: “Each additional patient per nurse was associated with a 7% … increase in the likelihood of dying within 30 days of admission and a 7% … increase in the odds of failure-to-rescue.”
• Elevated Failure-to-Rescue Rates: Hospitals with higher patient-to-nurse ratios experienced significantly increased rates of death among patients who developed complications.
• Burnout and Dissatisfaction: “Each additional patient per nurse was associated with a 23% … increase in the odds of burnout and a 15% … increase in the odds of job dissatisfaction.”
• Impact of Staffing Ratios: Simulation analyses estimated that increasing the patient-to-nurse ratio from 4:1 to 8:1 could result in thousands of preventable deaths in similar hospitals nationwide.

Conclusions:

• The study demonstrates a strong correlation between higher patient-to-nurse ratios and increased risk-adjusted 30-day mortality, failure-to-rescue rates, nurse burnout, and job dissatisfaction.
• Findings support the rationale behind California’s legislation mandating minimum patient-to-nurse ratios to improve patient outcomes and nurse retention.
• Investing in increased registered nurse staffing is likely to reduce preventable deaths, improve the quality of care, and potentially decrease hospital costs associated with nurse turnover.

Implications:

• This study provides crucial evidence for policymakers and hospital administrators concerning the importance of adequate nurse staffing levels.
• It highlights the direct link between nursing care and patient safety, advocating for policy changes and resource allocation to address the nursing shortage.
• The findings emphasize the need for further research to determine optimal staffing ratios and assess the long-term impact of staffing level interventions on both patient and nurse outcomes.

FAQ

What is the main finding of this study?

This study found a strong association between higher patient-to-nurse ratios and increased risk of patient mortality, especially among surgical patients who experience complications. Conversely, hospitals with more favorable patient-to-nurse ratios had lower rates of mortality and failure-to-rescue. The study also showed that higher patient-to-nurse ratios are linked to increased job dissatisfaction and burnout among nurses.

How was this study conducted?

Researchers analyzed data from 168 non-federal adult general hospitals in Pennsylvania. The data included surveys from over 10,000 staff nurses, discharge records of about 232,000 general, orthopedic, and vascular surgery patients, and administrative data from the hospitals. The researchers linked this data to examine the relationship between nurse staffing levels and patient outcomes, as well as nurse job satisfaction and burnout.

What did the researchers find regarding nurse burnout and job dissatisfaction?

The study found that for every additional patient added to a nurse’s workload, the odds of that nurse experiencing burnout increased by 23%, and the odds of job dissatisfaction increased by 15%. These findings suggest that heavier workloads contribute significantly to nurse burnout and job dissatisfaction.

How does patient-to-nurse ratio affect patient mortality?

For each additional patient added to a nurse’s workload, the study found a 7% increase in the likelihood of a patient dying within 30 days of admission. This risk was even more pronounced in patients who experienced complications after surgery.

What is “failure-to-rescue,” and how is it affected by nurse staffing?

“Failure-to-rescue” refers to deaths that occur within 30 days of admission among patients who developed complications during their hospital stay. This study found that hospitals with higher patient-to-nurse ratios had significantly higher rates of failure-to-rescue. This highlights the critical role nurses play in identifying and responding to patient deterioration.

How does this research support the implementation of minimum nurse-to-patient ratios?

A6: This study provides evidence that mandating minimum nurse-to-patient ratios, such as the legislation passed in California, is a credible approach to improving patient safety and reducing mortality rates in hospitals. The findings suggest that lower ratios lead to better patient outcomes.

What are the potential cost implications of improving nurse staffing levels?

A7: While increasing nurse staffing requires an upfront investment, this study suggests that it can lead to long-term cost savings for hospitals. Improved staffing can reduce costly nurse turnover by decreasing burnout and job dissatisfaction. Additionally, by reducing preventable deaths and complications, hospitals can avoid the significant costs associated with treating those adverse events.

What are the limitations of this study?

One limitation of the study is the potential for response bias in the nurse surveys, as the response rate was 52%. However, the researchers compared the demographics of their sample with a national survey and found them to be comparable, suggesting the results may be generalizable. Additionally, because the study used a cross-sectional design, it cannot definitively prove a cause-and-effect relationship between nurse staffing and patient outcomes. Longitudinal studies are needed to strengthen the evidence base.

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